title: Diabetes and thrombolysis for acute stroke: a clear benefit for diabetics.
abstract: OBJECTIVE
  Diabetes is a predictor for poor outcome after thrombolysis in stroke patients, and early post-stroke glycaemia is associated with higher rates of post-thrombolytic symptomatic intracerebral haemorrhages (SICHs). Diabetic stroke patients may nevertheless profit from thrombolysis. Here, we compared outcome data of matched thrombolysed and non-thrombolysed diabetic and non-diabetic stroke patients from a national database.
  
  
  METHODS
  The outcomes of 1079 matched quadruples, each consisting of a thrombolysed diabetic, a non-thrombolysed diabetic, a thrombolysed non-diabetic and a non-thrombolysed non-diabetic case (a total of 4316 cases), enrolled in the Austrian Stroke Unit Registry (2004-2013), were compared. Patients were matched according to sex, age, stroke severity, pre-stroke disability and prior stroke.
  
  
  RESULTS
  A regression model with improvement as depending variable found no effect of diabetes (P = 0.158) or the interaction diabetes × thrombolysis (P = 0.507), whereas the effect of thrombolysis itself was highly significant (P < 0.001). Functional outcome (modified Rankin Scale) was significantly better in thrombolysed than in non-thrombolysed diabetic patients at discharge from the stroke-unit (P < 0.001) and 3 months later (P = 0.006). No significant differences were found in the number of SICHs after thrombolytic treatment between diabetic (4.9%) and non-diabetic strokes (3.5%). Both groups had a higher risk of SICH compared with the non-thrombolysed groups (diabetics 2.6%, non-diabetics 2.5%). Due to lack of documentation, the effect of admission blood glucose on SICH was not investigated.
  
  
  CONCLUSIONS
  Data from this nationwide survey show that diabetic stroke patients receive a substantial benefit from thrombolysis, and therefore diabetic strokes should not be excluded from thrombolytic treatment.
authors.affiliation: Department for Clinical Neurosciences and Preventive Medicine, Danube University, Krems, Austria; Department of Neurology, Danube Clinic Tulln, Tulln, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Reiter
authors.forename: Y
authors.initials: Y
authors.lastname: Teuschl
authors.forename: K
authors.initials: K
authors.lastname: Matz
authors.forename: L
authors.initials: L
authors.lastname: Seyfang
authors.forename: M
authors.initials: M
authors.lastname: Brainin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy
keywords: diabetes; intravenous thrombolysis; stroke